The University Record, July 30, 1997
By Deborah Gilbert
News and Information Services
The initial stage of a major depression, which recurs in 50 percentto 85 percent of all patients who experience a first epi sode, is like astealth bomber. It seems to fly under a patient’s radar in the guise ofvaguely negative, uncomfortable emotions that patients don’t at first identifyas warning signs of depression.
Instead–even though they have experienced major dep ression before–patientsdeny what they glimpse on their psychic screens, attribute their fatigueand stress to external demands, and put on a front to conceal their distress,according to a study from the School of Nursing.
“It is important for patients and their families to learn how torecognize the early warning signs of an oncoming depression because earlyintervention can prevent or minimize relapse or recurrence,” saysBonnie M. Hagerty, assistant professor of nursing. “There is som eevidence that the ‘prodromes’ or early symptoms of depression, while theyvary from patient to patient, are fairly consistent within each patient.
“Also, research suggests that patients generally experience atleast one psychiatric symptom prior to the onset of depressed mood–generalizedanxiety, perhaps, or sadness, irritability, impaired work, decreased initiative,loss of interest, fatigue or insomnia.”
Hagerty’s study of the early warning signs and subsequent course ofmajor depres sion is reported in the April issue of the Journal of Orthopsychiatry.She and her colleagues conducted a series of focus group sessions overthe course of a year with 16 people who had experienced more than one episodeof depression.
The U-M r esearchers identified four consistent themes in the onset stagesof depression:
- Something’s Not Right: The duration of this stage varied from daysto months, both within and between study participants, but generally theparticipants said they den ied the symptoms; blamed their negative feelingson stress, the weather or other external difficulties; and expended considerableenergy putting up a front even though they felt unwell.
“Patients should try to monitor themselves when they feel thatsomething is not right, and acknowledge the possibility that depressionmay be setting in so they can catch it in time before they spiral down.”
- Something’s Really Wrong: Participants’ symptoms became more standardand focused. Their sleepin g and eating patterns changed and their energyand the ability to concentrate evaporated. Participants also said theywithdrew from others, became anxious and had thoughts of suicide.
“Participants who took action at this point–who sought ther apyor were able to provide some sort of self-help–felt more control overtheir emerging depressions and were often able to relieve and shorten theepisodes.”
- The Crash: One to three specific or pivotal symptoms develop–difficultieswith sleep, cognition, personal relationships and physical safety–signalingthe beginning of an acute episode of depression.
- Getting Connected: Getting connected meant seeking help from a familymember, friend or therapist. “This is a critical st age. All the participantsfelt an intense need to find a person who would listen to them and providefeedback and beneficial assistance. We can’t emphasize enough how importantit is for mental health professionals to listen to symptoms, show concernand prov ide encouragement.”
Hagerty’s colleagues on the study were Reg A. Williams, associate professorof nursing, and Michelle Liken, doctoral candidate in nursing.
